Sadler v. General Medical Council (GMC)

Factual and Procedural Background

The Appellant is a consultant obstetrician and gynaecologist whose professional performance between 1997 and 2000 came under scrutiny after several adverse surgical incidents at The Hospital. Regulation of medical practitioners is carried out by Company A under the Medical Act 1983 and the Medical (Professional Performance) Act 1995. An assessment panel reported serious concerns and, following an unsuccessful remedial training programme, a Case Co-ordinator referred the matter to the Committee on Professional Performance (“CPP”) under rule 25(1)(b)(i) of the General Medical Council (Professional Performance) Rules 1997 (“the Rules”).

After a sixteen-day performance hearing, the CPP found the Appellant’s professional performance “seriously deficient” in operative care and imposed three years of conditional registration. The Appellant appealed to the Judicial Committee on five questions of law.

Legal Issues Presented

1. Whether the Case Co-ordinator’s referral to the CPP complied with rule 25(1)(b)(i) and, if not, whether the CPP lacked jurisdiction.
2. Whether the CPP’s adverse findings in four “index” surgical cases were unsupported by or based on a misunderstanding of the evidence.
3. Whether the CPP erred by making findings that exceeded the case advanced by Company A.
4. What standard of proof applies in CPP proceedings and whether it was met.
5. Whether the composition of the CPP created apparent bias contrary to Article 6 ECHR.

Arguments of the Parties

Appellant's Arguments

• The referral letter did not satisfy rule 25(1)(b)(i) because any alleged non-compliance with the Statement of Requirements post-dated its expiry, depriving the CPP of jurisdiction.
• Findings on each index case (1, 2, 5 and A) were irrational or unsupported; for example, classifying a vaginal ovarian cystectomy as a “major error” and criticising intra-operative decisions that were merely “considered options.”
• The CPP relied on matters never put in issue by Company A, contrary to natural justice.
• The CPP purported to apply the criminal standard of proof (“sure”) but could not rationally reach that level of satisfaction on the evidence.
• A tribunal largely comprised of members of Company A acts as “prosecutor, judge and jury,” giving rise to an appearance of bias.

Company A’s Arguments

• Rule 25(1)(b)(i) was properly engaged because the Appellant was in continuing non-compliance when referred; the obligation persisted until the Statement of Requirements ceased to have effect in November 2000.
• Each index case revealed unsafe operative technique and formed part of a pattern of seriously deficient performance.
• The CPP confined itself to the pleaded case; it was entitled to disregard inadmissible “third-party interviews” yet rely on the live evidence.
• The CPP correctly adopted, or at least did not exceed, the criminal-equivalent standard, which was satisfied.
• The CPP’s statutory safeguards (lay membership, legal assessor, open procedure, and appellate oversight) negate any suggestion of apparent bias.

Table of Precedents Cited

Court's Reasoning and Analysis

Jurisdiction: The court held that the Statement of Requirements imposed a continuing obligation until November 2000. Consequently, non-compliance existed at the referral date (2 November 2000), validating jurisdiction under rule 25(1)(b)(i). The legal assessor’s alternative reasoning, although partly incorrect, did not vitiate the proceedings.

Findings on Index Cases: The court scrutinised each of the four operations:

• Index 1: Vaginal removal of an ovarian cyst was a “major error” given its rarity and required expertise.
• Index 2: The Appellant’s consideration of abdominal closure amidst haemorrhage illustrated inadequate judgment and reliance on unsafe technique.
• Index 5: While the term “unorthodox” was strong, the second return to theatre for major bleeding substantiated concern over surgical technique.
• Case A: Ureteric damage during supervised hysterectomy evidenced faulty anatomical identification; supervision did not transfer responsibility.

The court concluded that, individually and cumulatively, the incidents demonstrated a pattern of seriously deficient operative performance.

Scope of Case: The CPP confined itself to matters advanced by Company A; disregarding inadmissible interview material after advice from the legal assessor was proper.

Standard of Proof: Although the CPP was instructed to be “sure,” the court affirmed that the evidence met even the criminal-equivalent threshold. The court clarified prospectively that the ordinary civil standard generally applies, with a heightened civil standard only in exceptional circumstances.

Bias Allegation: Structural safeguards (lay members, legal assessor, statutory tenure, and broad appellate review) satisfied the impartiality requirements under both domestic law and Article 6 ECHR.

Holding and Implications

APPEAL DISMISSED.

The CPP’s conditional-registration order remains in force. The decision affirms the CPP’s jurisdictional reach where a practitioner remains in continuing non-compliance, clarifies that the ordinary civil standard of proof generally governs performance hearings, and confirms that Company A’s tribunal structure meets Article 6 requirements. No new precedent of broader application was created, but future panels are guided on evidential standards and assessor roles.